Chronic Obstructive Sleep Apnea Research Articles

Protocol for a randomized controlled trial of moderate intensity interval training in individuals with chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome who have excessive daytime sleepiness

BackgroundThe term “Overlap Syndrome” (OS) describes the presence of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a single individual. Excessive daytime sleepiness (EDS) is a common symptom of OS shown to be associated with an increased risk of cardiovascular disease (CVD) that could be reduced through exercise. Thus, we propose to investigate a novel exercise intervention in individuals with the EDS-OS phenotype as they are at highest risk of CVD yet have the greatest barriers to exercise. MethodsWe will conduct a single-site, randomized, two-arm, parallel group-controlled exercise trial in individuals with EDS-OS. The Epworth Sleepiness Scale (ESS) will be assessed at baseline. Individuals with OS and the EDS-OS phenotype (ESS >10) (n = 46) will be randomized to a moderate intensity interval training (MIIT, i.e. intervals of 5 min at 50% VO2peak followed by 3 min of active recovery at 10% VO2peak) or a control group of standard of care. We will investigate if MIIT intervention decreases the risk of CVD in EDS-OS, which will be assessed by: 1) quality of life, measured by the 36-Item Short Form Health Survey; 2) physical activity, measured by daily step counts; and 3) cardiovascular health, assessed as VO2peak, flow-mediated dilation and serum high sensitivity C-reactive protein, lipids, and glucose. ConclusionOur findings will guide future development and implementation of exercise interventions that could reduce the risk of CVD in the understudied EDS-OS phenotype.

The Effect of Positive Airway Pressure Therapy on Cardiac Remodelling and Cardiovascular Risk Factors in Patients With the Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnoea Overlap Syndrome: The REMAPS Study

The Effect of Positive Airway Pressure Therapy on Cardiac Remodelling and Cardiovascular Risk Factors in Patients With the Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnoea Overlap Syndrome: The REMAPS Study

Bilateral spontaneous Descemet membrane detachment after uneventful immediate sequential bilateral cataract surgery

Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a practice on the rise. To the authors' knowledge, this is the first reported case of bilateral Descemet membrane detachment (DMD) after uneventful same-day ISBCS, with emphasis on diagnosis and management. Patient and Clinical Findings: The case of a 66-year-old diabetic woman with chronic obstructive pulmonary disease and obstructive sleep apnea on home oxygen who developed spontaneous bilateral DMD after uneventful ISBCS for visually significant cataracts is presented. Although spontaneous DMD after uneventful phacoemulsification has been reported before, it has not been reported after same-day ISBCS to the authors' knowledge. The success rates with air pneumatic descemetopexy are excellent, with ranges between 90% and 95%. In this case, surgical intervention with gas injection in the anterior chamber and surgical peripheral iridotomies resulted in excellent visual acuity restoration in the patient. Diagnosis, Intervention, and Outcomes: Patient underwent same-day ISBCS under local anesthesia by different surgeons in either eye. Standard phacoemulsification techniques were used, and no intraoperative complications were noted. The patient returned with bilateral counting fingers vision 4 weeks postoperatively and reported her vision never improved after her cataract extraction. Anterior segment optical coherence tomography (AS-OCT) confirmed the presence of bilateral DMDs. Because of the patient's severely impaired vision, bilateral air descemetopexies were performed with clinical resolution of the DMD and excellent restoration of vision in both eyes. Conclusions: Sufficient evidence supports that performing ISBCS using internationally agreed protocols minimizes the risk of experiencing bilateral complications to a negligible level when compared with staged surgery. However, with ISBCS being on the rise, spontaneous bilateral DMDs may also be seen increasingly in those eyes with no underlying commonly recognized risk factors for spontaneous DMD. With unilateral DMD, watch and wait is a viable option. However, in bilateral DMD cases, earlier air or gas descemetopexy may be preferable to increase the likelihood of success and reduce the patient's period of decreased vision.

PSYCHOPATHOLOGY OF EMOTIONAL SPHERE IN PATIENTS WITH CHRONIC CEREBRAL ISCHEMIA AND OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea (OSA) is the most common sleep disorder globally. OSA affects 2–6 % of the adult population and 15–26 % of those aged over 70. The main daytime OSA symptoms are daytime sleepiness, decreased mood and concentration. Patients with chronic cerebral ischemia (CCI) often have the same complaints. Although such symptoms characterize emotional and affective disorders, the patients are usually treated by neurologists. The purpose of the study is to identify the characteristics of emotional and affective disorders in patients with chronic cerebral ischemia and obstructive sleep apnea. Materials and Methods. The study involved 45 patients aged 50–78 with CCI, type 1–2. Patients were examined for OSA and underwent cardiorespiratory monitoring. The psychoemotional status of individuals with CCI and OSA was assessed according to HADS, SHAPS, and ESS. Statistical analysis of cardiorespiratory monitoring parameters determined the critical level of average night saturation, at which depressive symptoms are detected. Results. It was found that patients with severe OSA had more severe depressive symptoms and anhedonia, but lower anxiety levels compared with CCI patients without severe OSA. The authors determined critical levels of mean night saturation for development of depression (SpO2avrg<89 %) and clinically significant depression (SpO2avg<87 %). Conclusion. Depression is proved to be the most common emotional disorder in patients with CCI and concomitant OSA. The authors determined critical levels of average night saturation for depressive disorders in patients with CCI type 1–2.

The Use of Podcasts as Patient Preparation for Hospital Visits-An Interview Study Exploring Patients' Experiences.

Podcasts have emerged as a promising tool in patient preparation for hospital visits. However, the nuanced experiences of patients who engage with this medium remain underexplored. This study explored patients' experiences of receiving information by way of podcasts prior to their hospital visits. Semi-structured interviews were conducted with patients with suspected chronic obstructive pulmonary disease (COPD), lung cancer, or sleep apnea. The method of data analysis chosen was thematic analysis. Based on data from 24 interviews, five key themes were identified: technical challenges in utilization of podcasts; individual preferences for information prior to hospital visits; building trust and reducing anxiety through podcasts; the role of podcasts as an accessible and convenient source of information; and enhancement of engagement and empowerment through podcasts. Additionally, the study highlighted the critical importance of tailoring podcasts' content to individual preferences to optimize the delivery of healthcare information. Podcasts can serve as a meaningful supplement to traditional information sources for patients. However, it is important to recognize that not all patients may be able to engage with this medium effectively due to technical challenges or personal preferences.

Differences in Anthropometric, Sleep and Respiratory Characteristics between Hypercapnic and Normocapnic Patients with COPD-OSA Overlap Syndrome.

Overlap syndrome (OS), the coexistence of chronic obstructive pulmonary disease and obstructive sleep apnea, is frequently characterized by the presence of daytime hypercapnia (pCO2 ≥ 45 mmHg). The aim of this study was to investigate potential differences in anthropometric, sleep and respiratory characteristics between hypercapnic and normocapnic patients with OS. Consecutive patients who underwent polysomnography, pulmonary function testing and arterial blood gases and had been diagnosed with OS were enrolled in the study. According to pCO2 levels in wakefulness, the patients were divided into group A, consisting of OS patients without hypercapnia (n = 108) or group B, consisting of OS patients with hypercapnia (n = 55). The majority of included patients in both groups were males (n = 92 in group A vs. n = 50 in group B). Group B had increased BMI (p = 0.001), neck (p = 0.017) and waist circumference (p = 0.013), higher scores in Epworth sleepiness scale (ESS) (p = 0.008), increased sleep efficiency (p = 0.033), oxygen desaturation index (p = 0.004) and time with oxyhemoglobin saturation <90% (p = 0.006) than group A. Also, Group B had decreased average and minimum oxyhemoglobin saturation during sleep (p < 0.001). Hypercapnic patients had lower FEV1% (p = 0.003), FVC% (p = 0.004), pO2 and pCO2 (p < 0.001 for both) values compared with normocapnic patients. In binary regression analysis, which assessed various predictors on the likelihood of having hypercapnia, it was found that BMI (OR: 1.313, 95% CI: 1.048-1.646, p = 0.018) and FVC (OR: 0.913, 95% CI: 0.845-0.986, p = 0.020) were the major determinants of hypercapnia in OS patients. Hypercapnic OS patients were more obese and sleepy and presented worse respiratory function in wakefulness and sleep hypoxia characteristics compared with normocapnic OS patients.

Endoscopic Powered Intracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea With High-Risk Comorbid Disease Conditions: A Case Series.

Pediatric obstructive sleep apnea (OSA) caused by adenoids or an enlarged palatine tonsil has a negative impact on physical and mental growth. Surgical removal of the tissue is effective but entails a life-threatening risk of postoperative bleeding, which is up to 30 times higher in chronic pediatric disease cases. However, endoscopes and resection devices provide safe, reliable surgical methods. Here, we report the efficacy and safety of endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) for pediatric OSA in patients with high-risk comorbidities. This retrospective case series included pediatric patients with OSA who underwent PITA at a single tertiary medical center between April 2017 and May 2023. Ten patients (three males and seven females; mean age 6.4 years, range 2-12 years) were included; all met the Japanese criteria for complex chronic pediatric conditions. The average operative time was 61 min; a microdebrider was used in eight cases and a coblator in two cases. Although there was no postoperative bleeding, one case experienced regrowth. Our data show that an endoscopic PITA approach could reduce the risk of severe bleeding and relieve the sleeping conditions of pediatric patients with complex chronic OSA.

Home non-invasive ventilation: An observational study of aetiology, chronic respiratory failure of multiple aetiologies, survival and treatment adherence

Home non-invasive ventilation (NIV) is used to treat patients with chronic respiratory failure (CRF). However, knowledge on the prevalence and impact of multimorbid aetiology of CRF, patterns of NIV use, and survival of these patients is limited. Our aim was to analyse the multiple aetiologies of CRF, patterns of NIV use and the outcome of those patients.We conducted a retrospective analysis of 1,281 patients treated with home-NIV between 2004 and 2014 in Turku University Hospital, Finland. The patients were divided into nine disease categories: obstructive airways disease (16 %); obesity hypoventilation syndrome (11 %); neuromuscular disease (10 %); chest wall diseases (4 %); sleep apnoea (26 %); interstitial lung diseases (3 %); malignancy (2 %); other (3 %) and acute (8 %), which refers to the patients who did not fulfil criteria of CRF. In addition, multiple aetiologies of CRF were found in 17 %. Mean adherence to home-NIV was 6.0 ± 4.4 h/d and median treatment duration 410 (120–1021) days. Adherence, treatment duration or survival did not significantly differ between patients with either single or multiple causative diseases leading to CRF. Median survival was 4.5 years (95 % CI 3.6 to 5.4). The main reasons for discontinuing NIV were death (56 %) and lack of motivation (19 %).We conclude that home-NIV is used in a variety of diseases. CRF of multiple aetiologies is prevalent and not limited to chronic obstructive lung disease and obstructive sleep apnoea overlap syndrome. However, the adherence to home-NIV or survival did not differ between patients with a single or multiple diseases causing CRF, but the survival of the home-NIV patients differed according to the underlying aetiology of CRF.

Peritonsillar Block with Triamcinolone as a Preemptive Analgesia in Tonsillectomy with Bipolar Electrocauter

Background: Tonsillectomy is one of the common types of ear, nose, and throat (ENT) surgery. Patients undergoing tonsillectomy frequently experience significant postoperative pain due to oropharyngeal muscle spasms and irritation of afferent nerve fibers. According to previous studies, triamcinolone for peritonsillar block was used to reduce postoperative pain in patients who have undergone tonsillectomy. The aims and objectives of this study were to observe the effectiveness of peritonsillar block using triamcinolone for reducing pain in patients with post-tonsillectomy using the bipolar electrocautery technique. Case: A 34-years-old male patient with chronic tonsillitis and obstructive sleep apnea (OSA) was undergoing tonsillectomy with general anesthesia and peritonsillar block after general anesthesia with triamcinolone 0,5 mg/kg body weight in the right and left fossa peritonsillar. Postoperative hemodynamic monitoring was carried out in the inpatient room. Patients were assessed for pain scale after tonsillectomy and side effects of triamcinolone, with pain indicator using the Wong-baker faces pain rating scale, numeric pain rating scale, and Face, legs, activity, cry and consolability (FLACC) Scale. Pain scales were assessed 1 hour after the tonsillectomy in the recovery room, 3 hours after the tonsillectomy in the inpatient room, 8 hours after the tonsillectomy in the inpatient room, 1 day after the tonsillectomy in the inpatient room, and 2 days after the tonsillectomy by phone. The patient went out of the hospital after 1 day of tonsillectomy. Conclusion: Peritonsillar block with triamcinolone is effective in reducing pain after tonsillectomy and can be the drug of choice when administering peritonsillar block.

The relationship between sleep and innate immunity.

Sleep regulates inflammatory responses, and the innate immune system affects sleep. Interleukin-1 beta, tumor necrosis factor alpha, growth hormone-releasing hormone, prolactin, and nitric oxide are somnogenic substances. Sleep deprivation, such as chronic insomnia or obstructive sleep apnea, affects cytokine production, glial function, natural killer cell activity, and inflammasome function. This review will discuss the relationship between sleep and innate immunity.

Prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam.

Chronic obstructive pulmonary disease and obstructive sleep apnea are two common respiratory diseases. Chronic obstructive pulmonary disease patients co-morbid with obstructive sleep apnea are associated with increased cardiovascular adverse events, frequent acute exacerbations, and higher mortality. Only a few studies on obstructive sleep apnea among patients with chronic obstructive pulmonary disease are available in Vietnam. The study aims to determine the prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam. This is a cross-sectional study in patients with chronic obstructive pulmonary disease at multi-sites in Vietnam: the People's Hospital of Gia Dinh, Bach Mai Hospital, Phoi Viet Clinics, and Lam Dong Medical College using type 3 sleep monitoring device at sleep labs to diagnose obstructive sleep apnea in all study participants. Two hundred seventy-eight patients with chronic obstructive pulmonary disease were enrolled. Among the patients, 93.2% were male, with an average age of 66.9 ± 9.3 and a BMI of 21.9 ± 3.8kg/m2; 82.0% were symptomatic including 44.6% in group B and 37.4% in group D with average post-FEV1 of 49.8 ± 18.3% predicted values. One hundred seventeen patients (42.1%) with chronic obstructive pulmonary disease presented obstructive sleep apnea defined by AHI ≥ 15 events/h. The prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam was 42.1% for an AHI of ≥ 15 events/h.

0504 Unraveling the Relationships Between Chronic Illness, Healthcare Access, and Obstructive Sleep Apnea in Nigeria

0504 Unraveling the Relationships Between Chronic Illness, Healthcare Access, and Obstructive Sleep Apnea in Nigeria

Pulmonary hypertension in newly diagnosed obstructive sleep apnea-chronic obstructive pulmonary disease overlap syndrome patients attending a tertiary care centre-a cross-sectional analysis.

Overlap syndrome is the association of obstructive sleep apnea (OSA) with chronic obstructive pulmonary disorder and with other chronic respiratory diseases. Patients with overlap syndrome have a worse prognosis compared with chronic obstructive pulmonary disorder or OSA alone. Additionally, patients with combined chronic obstructive pulmonary disorder and OSA are more likely to develop pulmonary hypertension and right heart failure much earlier than those without overlap. To assess the occurrence of pulmonary hypertension (PH) in newly diagnosed OSA-chronic obstructive pulmonary disorder overlap syndrome patients attending a tertiary care centre. This cross-sectional study was conducted at Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, South India, among patients with OSA above 40years of age who were proactively evaluated to pick out those with undiagnosed overlap. A period of 6months after getting ethical clearance from June 2018 was selected as the study period. Among patients with symptoms suggestive of OSA above 40years of age who gave the informed consent were enrolled after screening with Standard Sleep questionnaires (Berlin questionnaire, STOP BANG and Epworth Sleepiness Scale). Enrolled patients underwent routine spirometry and sleep study using the standard Level 1 overnight polysomnography (Level1 OPSG). Patients were classified in to two groups as OSA patients (group I), having an apnea hypopnea index (AHI) > 5/hr alone and the second group as those OSA patients (group II), with an obstructive spirometry pattern who were the overlap group. Arterial blood gas analysis (a sample of radial arterial blood was drawn with the patient awake and supine, and was analyzed for pH, PaCO2 and PaO2) and echocardiography (ECHO) of the two groups were compared as a non-invasive method to assess pulmonary artery hypertension and results were analyzed in a systematic manner. Among the 84 patients enrolled, 16.7% had overlap syndrome and the rest had OSA alone. Statistically significant higher mean weight and BMI for those with overlap syndrome compared to the OSA group were observed. Mean FVC (forced vital capacity), FEV1 (forced expiratory volume 1s), and FEV1/FVC were lower in those with overlap syndrome compared to OSA group. The mean values of ABG parameters revealed higher PaCO2 and lower PaO2 among the group with overlap syndrome which were statistically significant. However, there was no significant difference in resting room air SaO2 value between the two groups. The mean values of sleep duration and efficiency were significantly lower in those with overlap syndrome with a p value < 0.001. The mean value of arousal and REM (rapid eye movement) sleep percentage were significantly higher among those with overlap syndrome (p < 0.001). Mean value of NREM (non-rapid eye movement) sleep percentage was lower among the group with overlap syndrome compared with the OSA group, and this difference was statistically significant. The mean AHI value of the overlap syndrome group was 39.79 ± 7.54 and this was significantly higher than the OSA group (p < 0.004). Among the 14 patients who had ECHO evidence of pulmonary hypertension, 9 (64.3%) belonged to the overlap group which shows that they are a highly vulnerable group for developing pulmonary hypertension (PH) and requires early detection and more rigorous treatment. This study confirms that OSA patients with modest daytime level of hypoxemia and mild-moderate chronic airflow limitation have a high prevalence of PH. Chronic airway obstruction may be asymptomatic in some subjects and this stresses the necessity of pulmonary function test in OSA.

Clinical characteristics of obstructive sleep apnea in patients with heart failure

Aims: To investigate the clinical characteristics of obstructive sleep apnea syndrome in patients with heart failure (HF).&#x0D; Patients and Methods: From 9/2020 to 9/2021, patients with chronic HF (European Society of Cardiology’s criteria) and obstructive sleep apnea (American Academy of Sleep Medicine’s criteria) were enrolled into the study. Clinical examination, blood test, echocardiography, polysomnography, ventilatory polygraphy were performed in all patients.&#x0D; Results: 63 patients were included: 54 male (85.7%), 9 female (14.3%), age 69.57 ± 13.08, BMI 28.63 ± 4.16 kg/m2, neck size &gt;40 cm: 69.3%, 100% male and 88.9% female had waist circumference ≥90 cm, hypertension 78.4%, diabetes 47.6%, HFrEF 12 (18%), HFmrEF 5 (7.9%), HFpEF 46 (73%). 68.3% patients had Epworth ≥10, snoring 92.1%. Compared to patients with apnea-hypopnea index (AHI) &lt;15 and AHI 15-30, patients with AHI&gt;30 had thicker interventricular septum, higher left ventricular mass (LVM) and LVM index, lower e’ velocity, higher E/e’ ratio, higher left atrial volume index, higher systolic artery pulmonary pressure, p&lt;0.05. Multivariate regression showed that age, body mass index, neck size, HbA1C were independent predictors of high AHI, p&lt;0.05.&#x0D; Conclusions: Majority of patients with chronic HF and obstructive sleep apnea were male, old age, overweight/obesity, and had large neck size. Hypertension and diabetes and heart failure with preserved ejection fraction were prevalent. Patients with AHI&gt;30 had higher interventricular septal thickness, higher LVM and LVM index, lower e’ velocity, higher E/e’ ratio, higher left atrial volume index, higher systolic artery pulmonary pressure, p&lt;0.05. Age, body mass index, neck size, HbA1C were independent predictors of high AHI, p&lt;0.05.

The association between adipokines and pulmonary diseases: a mendelian randomization study

BackgroundThe role of adipokines in the development of lung diseases is significant, yet their specific relationship with different lung diseases remains unclear.MethodsIn our research, we analyzed genetic variations associated with adipokines and various lung conditions such as interstitial lung disease, chronic obstructive pulmonary disease, asthma, lung cancer, sleep apnea, pneumonia, and tuberculosis, using data from public genome-wide studies. We employed Mendelian randomization techniques, including inverse variance weighting, weighted median, and MR-Egger regression methods, and conducted sensitivity checks to validate our findings.ResultsA study using the FinnGen database, which included 198,955 participants, identified 13 SNPs associated with adiponectin. Notably, adiponectin was found to significantly reduce the risk of interstitial lung disease and idiopathic pulmonary fibrosis. However, little evidence was found to establish a direct cause-effect relationship between the six adipokines and several other lung conditions, including sarcoidosis, asthma, chronic obstructive pulmonary disease, lung cancer, tuberculosis, pneumonia, and sleep apnea syndrome.ConclusionThis study reveals a reverse link between adiponectin levels and the likelihood of interstitial lung disease, including idiopathic pulmonary fibrosis.

The Overlap Syndrome: A Combination of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea.

Chronic obstructive pulmonary disease (COPD) is a severe lung disease that results in persistent and progressively worsening airflow obstruction due to abnormalities in the airway and alveoli. Obstructive sleep apnea (OSA) is a critical condition characterized by obstructive apneas, hypopneas, and respiratory effort-related arousals. These events occur due to the repetitive collapse of the upper airway during sleep, and it is essential to address this condition. These two conditions, when co-occur, are known as overlap syndrome (OS), which is associated with a higher likelihood of morbidity and mortality compared to either condition alone. Effective management of overlap syndrome is critical to maintain normal oxygen levels during sleep and reduce the incidence of hypoxemia and hypoventilation while improving sleep quality. Positive pressure ventilation is a standard technique used to effectively lower hospitalizations, emergency room visits, moderate and severe exacerbations, and related healthcare expenses in patients diagnosed with COPD and OSA. Despite the lack of literature on overlap syndrome, it is imperative to understand that this condition requires prompt and effective management to prevent further complications. Therefore, this review provides a detailed discussion highlighting the importance of proactive measures to manage overlap syndrome.

Estimating the prevalence and clinical significance of chronic obstructive pulmonary disease-obstructive sleep apnea overlap in South Korea

IntroductionConcurrent obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are referred to as COPD-OSA overlap. We investigated the prevalence and clinical significance of COPD-OSA overlap in the general population of South Korea. MethodsData were obtained from the 2019 Korea National Health and Nutrition Examination Survey. Participants ≥40 years of age with complete STOP-Bang questionnaire and spirometry data were included. OSA was presumed in individuals with a STOP-Bang score of ≥3. COPD was determined using forced expiratory volume at 1 s/forced vital capacity <0.7. Participants were classified on the basis of the STOP-Bang score and spirometry findings. Clinical characteristics, comorbidities, and quality of life (using the EuroQoL 5-dimension instrument) were compared between the overlap group and COPD-alone or OSA-alone groups. ResultsAmong the 3157 participants, 6.9 % demonstrated COPD-OSA overlap. Individuals with OSA alone and COPD alone were 31.8 % and 5.2 %, respectively. The overlap group included more males, ever smokers, and frequent alcohol drinkers than the COPD- or OSA-alone groups. The overlap group had more diagnoses of hypertension, diabetes, and stroke than the COPD-alone group. The risk of anxiety/depression was approximately 2.5 times higher in the overlap group than in the COPD-alone group. COPD-OSA overlap was a significant risk factor for anxiety/depression after adjusting for age, sex, household income, and education levels. ConclusionCOPD-OSA overlap is not rare within the general population of South Korea. Patients with overlap showed more comorbidities and higher levels of anxiety/depression than those in the COPD-alone group.

Exercise and hypoxia-induced hypercoagulability is counterbalanced in women in part by decreased platelet reactivity

Hypoxia plays an important role in several pathologies, e.g. chronic obstructive pulmonary disease and obstructive sleep apnea syndrome, and is linked to an increased thrombosis risk. Furthermore, oxygen deprivation is associated with hypercoagulability.In this study, we investigated the effect of gender and exercise on the coagulation potential under hypoxic conditions at high altitude by assessing thrombin generation (TG) and platelet activation. Hereto, ten healthy volunteers were included (50 % male, median age of 27.5 years). The measurements were conducted first at sea level and then twice at high altitude (3883 m), first after a passive ascent by cable car and second after an active ascent by a mountain hike.As expected, both the passive and active ascent resulted in a decreased oxygen saturation and an increased heart rate at high altitude. Acute mountain sickness symptoms were observed independently of the ascent method. After the active ascent, platelet, white blood cell and granulocyte count were increased, and lymphocytes were decreased, without a gender-related difference. FVIII and von Willebrand factor were significantly increased after the active ascent for both men and women. Platelet activation was reduced and delayed under hypobaric conditions, especially in women. TG analysis showed a prothrombotic trend at high altitude, especially after the active ascent. Women had a hypercoagulable phenotype, compared to men at all 3 timepoints, indicated by a higher peak height and endogenous thrombin potential (ETP), and shorter lag time and time-to-peak. In addition, ETP and peak inhibition by thrombomodulin was lower in women after the active ascent, compared to men. Interestingly, data normalisation for subject baseline values indicated an opposing effect of altitude-induced hypoxia on α2-macroglobulin levels and TG lag time between men and women, decreasing in men and increasing in women.We conclude that hypoxia increases TG, as well as FVIII and VWF levels in combination with exercise. In contrast, platelets lose their responsiveness at high altitude, which is most pronounced after heavy exercise. Women had a more pronounced prothrombotic phenotype compared to men, which we theorize is counterbalanced under hypobaric conditions by decreased platelet activation.

The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease.

This study examined in-hospital outcomes for patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also known as COPD-OSA overlap syndrome, during hospitalizations for acute exacerbation of COPD. The National Inpatient Sample was used to examine in-hospital mortality, length of stay, costs, and utilization of supportive ventilation in patients with COPD-OSA overlap during acute exacerbation of COPD hospitalizations. A 1-to-1 matched case-control design was utilized to match patients with and without OSA. Multivariate logistic regression modeling was used to examine mortality and ventilatory support, while controlling for potentially confounding diagnoses. COPD-OSA overlap was associated with longer median length of stay (4 days OSA, 3 days non-OSA; P < .001), higher mean costs ($32,197 OSA, $29,011 non-OSA; P < .001), increased utilization of noninvasive positive-pressure ventilation (13.92% OSA, 6.78% non-OSA; P < .001), and when required for greater than 96 hours, earlier initiation of mechanical ventilation (2.53 days OSA, 3.35 days non-OSA; P = .001). However, COPD-OSA overlap was associated with reduced mortality (0.81% OSA, 1.05% non-OSA; P < .001). These differences in mortality (adjusted odds ratio: 0.650; 95% confidence interval: 0.624-0.678) and noninvasive positive-pressure ventilation usage (adjusted odds ratio: 1.998; 95% confidence interval: 1.970-2.026) remained when adjusted for confounders. Patients with COPD-OSA overlap have higher utilization of supportive ventilation and longer length of stay during acute exacerbation of COPD hospitalizations, contributing to higher costs. The diagnosis of OSA is associated with reduced mortality in these hospitalizations, which may be related to greater utilization of supportive ventilation when OSA is recognized. De la Fuente JRO, Greenberg P, Sunderram J. The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease. J Clin Sleep Med. 2024;20(6):863-870.

Profile of Sleep-related Breathing Disorders in Chronic Obstructive Pulmonary Disease-obstructive Sleep Apnea Overlap Syndrome

Introduction: Overlap syndrome (OS) is defined by the combined occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD). Sleep-related breathing disorders (SRBDs) in OS can also manifest with central sleep apnea (CSA) and hypoventilation; besides OSA. Methods: This study was carried out to evaluate various SRBD in OS and its therapeutic implications patients having postbronchodilator obstruction in spirometry with respiratory symptoms were classified as COPD. Those found to have an apnea–hypopnea Index (AHI) &gt;5/h in polysomnography (PSG) were diagnosed as OS. All 37 patients diagnosed as OS underwent a subsequent positive airway pressure (PAP) titration. Results: On the evaluation of the SRBD, over half (51%) of the patients had OSA with no hypoventilation. More than one-third of the patients (35%) had associated hypoventilation with OSA, three patients had hypercapnic CSA, and two patients had hypocapnic CSA with Cheyne–Stokes breathing (CSA-CSB). The OSA group was easily titrated and corrected by CPAP therapy. OSA with hypoventilation group had underlying COPD with severe obstruction requiring bilevel PAP titration. Patients with CSA-CSB were elderly hypertensive patients with congestive heart failure who were corrected by PAP and optimization of cardiac medications. Patients with hypoventilation and hypercapnic CSA were most difficult to titrate and needed a backup rate along with PAP therapy for correction. On classifying patients on the basis of severity of OSA and COPD, there was no correlation found between AHI and forced expiratory volume 1 (FEV1). Patients with mild COPD with severe OSA were easily titrated with CPAP with a mean pressure of 8 cm H2 0. The most challenging cases were with severe COPD with severe OSA who required high pressures in both exhalation PAP and inspiratory PAP titration; two of such patients required backup rate by spontaneous/timed mode of PAP therapy. Conclusions: There are many profiles of SRBD in OS, and a detailed in-hospital PSG with a PAP titration can help in effectively managing the patients.